Document Detail


Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment.
MedLine Citation:
PMID:  20851923     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
RATIONALE: In the critically ill patients, lung ultrasound (LUS) is increasingly being used at the bedside for assessing alveolar-interstitial syndrome, lung consolidation, pneumonia, pneumothorax, and pleural effusion. It could be an easily repeatable noninvasive tool for assessing lung recruitment.
OBJECTIVES: Our goal was to compare the pressure-volume (PV) curve method with LUS for assessing positive end-expiratory pressure (PEEP)-induced lung recruitment in patients with acute respiratory distress syndrome/acute lung injury (ARDS/ALI).
METHODS: Thirty patients with ARDS and 10 patients with ALI were prospectively studied. PV curves and LUS were performed in PEEP 0 and PEEP 15 cm H₂O₂. PEEP-induced lung recruitment was measured using the PV curve method.
MEASUREMENTS AND MAIN RESULTS: Four LUS entities were defined: consolidation; multiple, irregularly spaced B lines; multiple coalescent B lines; and normal aeration. For each of the 12 lung regions examined, PEEP-induced ultrasound changes were measured, and an ultrasound reaeration score was calculated. A highly significant correlation was found between PEEP-induced lung recruitment measured by PV curves and ultrasound reaeration score (Rho = 0.88; P < 0.0001). An ultrasound reaeration score of +8 or higher was associated with a PEEP-induced lung recruitment greater than 600 ml. An ultrasound lung reaeration score of +4 or less was associated with a PEEP-induced lung recruitment ranging from 75 to 450 ml. A statistically significant correlation was found between LUS reaeration score and PEEP-induced increase in Pa(O₂) (Rho = 0.63; P < 0.05).
CONCLUSIONS: PEEP-induced lung recruitment can be adequately estimated with bedside LUS. Because LUS cannot assess PEEP-induced lung hyperinflation, it should not be the sole method for PEEP titration.
Authors:
Belaïd Bouhemad; Hélène Brisson; Morgan Le-Guen; Charlotte Arbelot; Qin Lu; Jean-Jacques Rouby
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article     Date:  2010-09-17
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  183     ISSN:  1535-4970     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-02-03     Completed Date:  2011-09-29     Revised Date:  2012-03-22    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  341-7     Citation Subset:  AIM; IM    
Affiliation:
Multidisciplinary Intensive Care Unit Pierre Viars, Assistance Publique Hôpitaux de Paris. jjrouby@invivo.edu
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MeSH Terms
Descriptor/Qualifier:
Acute Lung Injury / physiopathology,  therapy,  ultrasonography*
Humans
Lung / physiology,  ultrasonography*
Middle Aged
Point-of-Care Systems*
Positive-Pressure Respiration*
Respiratory Distress Syndrome, Adult / physiopathology,  therapy,  ultrasonography*
Respiratory Function Tests
Tomography, X-Ray Computed
Treatment Outcome
Comments/Corrections
Comment In:
Am J Respir Crit Care Med. 2012 Feb 15;185(4):457; author reply 457-8   [PMID:  22336681 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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